A government vision for Scotland’s NHS and social care workforce lacks insight say health and care organisations, with the document being described as a rehash of old pledges and “arbitrary” commitments.

The National Workforce Strategy, co-produced with local authority organisation COSLA, stresses the need to plan, attract, train, employ and nurture staff across Scotland’s health and care sector over the next decade.

But organisations for both nursing staff and doctors believe the delayed strategy contains worrying gaps and lacks a clear delivery plan.

The Deputy Chair of the doctors’ union, BMA Scotland, Dr Bernie Scott, said: “The key missing section is on retention. It takes a long time to train doctors – yet, at the moment, we face the pressing risk of losing more and more of those we currently have.

“This strategy needed a much greater focus on how we prevent that, through fairer reward, finally sorting pensions tax charges, better work life balance – and just making NHS Scotland a more attractive place to work, with an improved culture and less of a focus on targets and blame.”

 

Where is retention?

A commitment to increase the NHS’s capacity by 10% by the end of this parliament, first mentioned in the government’s NHS recovery plan published last August, was reasserted today.

Numbers of training places for GPs, nurses and midwives, paramedics, allied health professionals, clinical scientists and medical students are all set to increase, as the government pledges to establish 1,800 more full-time posts over the next five years.

The strategy commits to recruiting 800 additional GPs by 2028. The BMA says this is a long established commitment.

Dr Scott says, while his organisation welcomes a commitment to increase medical training places by 100 each year, doctors will be “hugely disheartened” by the renewed attention on record staffing levels and capacity increases:

“These are not realistic statements given our NHS and its staff can barely cope with what is asked of it at the moment.

“We would also question the suggested 1% growth in staffing, which seems an arbitrary and unclear commitment and is difficult to tally with the hoped for growth in capacity, for example.”

The Royal College of Nursing Scotland said a 1% commitment was “inadequate” and questioned where the required staff would be found.

RCN Scotland Interim Director, Colin Poolman, said more must be done to retain nurses and called for the Health and Care Staffing Act - “ground-breaking” workforce planning legislation that would ensure correct levels of staffing - be urgently implemented:

“Action to address staff shortages is needed now and the lack of commitment to implementation of Scotland’s safe staffing legislation simply isn’t good enough.” 

Today’s document says the government will “redevelop the implementation timetable” of the act, and outline any changes that may result due to the creation of a National Care Service.

 

Vacancies & data

High numbers of vacancies within the medical and nursing workforce are of great concern to both professional organisations, with the BMA saying levels of consultant and speciality doctor vacancies are still substantially underestimated in official figures.

By the end of next month, the government says it will introduce an annual survey of the general practice workforce to better capture primary care workforce data – an area of knowledge the BMA says has “big gaps”.

RCN Scotland’s Mr Poolman said: “There is an emphasis on recruiting into the nursing profession but scant detail on how this will be achieved to tackle the record high levels of vacancies or how to retain existing experienced staff – many have told us low pay and poor staffing levels are driving them out of the profession.” 

Improving the quality of both data collection design and quality across the workforce is a focus says the government, as ministers revealed plans to review workforce growth projections annually for the first time. The first release will be published later this year.

Health and Social Care Secretary Humza Yousaf said: “While we have seen continued growth in our NHS and social care workforce over the past decade, we need more than sheer numbers alone as we continue to care for patients and plan for the future.

“This strategy is designed to embed a new long-term approach. It commits to understanding the change in demand for services as we recover, rebuild and transform our health service, and how we can achieve a more sustainable, skilled workforce which makes careers in health and social care – at all levels – more attractive.”

 

Social care & social work

A bespoke six-week pre-care course funded through the National Training Transition Fund was launched last month for those considering a career in the sector, says the government in its strategy.

Up to 1,800 training places are available, but Scottish Care says uptake must be closely monitored to ensure targets are “realistic” in light of the challenges facing the sector currently.

The strategy states a recruitment strategy for the social care sector is due by the end of this year.

A Scottish Care spokesperson said: “Initial discussion around creating a recruitment strategy for social care is being led by Scottish Government although the content of this strategy is still to be determined.”

Today’s strategy also includes a commitment to “increase the hourly rate of social care staff” within the next 24 months – when pressed for clarification on whether this meant the rise to £10.50 announced in the Scottish Budget in December, a Scottish government spokesperson told healthandcare.scot that “this involves future discussion”.

The often-overlooked part of the health and social care policy debate, social work, has been given some attention in today’s strategy – record funding of £22m will allow local authorities to build-in more workforce capacity and the government says it plans to develop a social work advanced practice career pathway.

The next 6-12 months will also see the development of a pilot graduate apprenticeship scheme to improve career pathways for social care staff into social work.

 

Local recruitment

A national Centre for Workforce Supply (CWS) to coordinate national and overseas recruitment campaigns, as first outlined in the Recovery Plan, will be established within NHS National Education for Scotland within the next two years at a cost of £11m.

International recruitment to health boards will also be supported with recurring funding of £1m per annum, today’s plan says.

NHS Fife recently welcomed the first of Scotland’s international recruits as part of a partnership with an English NHS trust, which will see up to 40 registered nurses join the board this year.

Councillor Stuart Currie, COSLA’s Health and Social Care spokesperson, said: “Partners working across health and social care must now adopt a strategic approach to the recovery, growth and transformation of the workforce that supports the wellbeing of workers, a continued shift to prevention and the provision of high-quality support and care for citizens.

“The values, outcomes and actions outlined in this strategy provide a foundation for excellence in planning, attracting, developing and nurturing the Health and Social Care workforce, at national and local levels.”

A number of high-priority items were not mentioned in today’s release, including the unique challenges of rural and remote areas’ workforce – though the government said it will develop a specific recruitment strategy by the end of 2024.